Mifepristone: Uses, Side Effects, Working, And Interactions
What Is Mifepristone?
Mifepristone is available in the market under three brand names – Mifeprex, Korlym, and RU486. The benefits of mifepristone in Mifeprex and RU486 are the same. Thanks to such options, buying Mifepristone has become easy these days.
It acts as an agent to terminate an implanted pregnancy in both the medicines. In Korlym, however, mifepristone works to control high blood sugar levels.
Initially, Mifeprex was approved by the FDA in 2000. Soon after, the marketing company made a few modifications regarding the dosage and administration of Mifeprex.
Thus, it was re-approved by the FDA in 2016. Korlym successfully gained its approval in 2012.
This article discusses everything about this drug. This includes the benefits of mifepristone, how it works, its side-effects, interactions, and so on.
Uses Of Mifepristone
For a medical abortion, mifepristone can be taken up to week 10 of the pregnancy. It inhibits progesterone production and successfully terminates the pregnancy when taken in combination with misoprostol.
The second use is to control hyperglycemia which occurs as a result of hypercortisolism in patients of Cushing’s syndrome. The doctor will decide the dosage of the medicines on a subjective basis.
Side-Effects Of Mifepristone
Along with the benefits of mifepristone also come a few unwanted effects. These side-effects can vary in severity and frequency of occurrence among its patients.
Severe side effects:
- Less frequent occurrence:
- Extremely heavy bleeding from the vagina
- Abnormal weakness or lethargy
- Unknown frequency of occurrence:
- Chest ache
- Quick, fragile pulse rate
- Fever or chills
- Aching arms, jaw, back, or neck
- Pain while urinating
- Short breaths
Some other symptoms that, if experienced, are not too severe. However, if they feel unusually amplified or refuse to subside, consult a doctor. These include:
Less severe side effects:
- Very frequent occurrence:
- Abdominal pain or backaches
- Cramps in the uterus
- Nausea or vomiting
- Less frequent occurrence:
- Symptoms of flu
- Heightened white discharge from the vagina
- Muscle weakness
- Itchy genital area
- Painful intercourse
- Issues while sleeping
- Issues while breathing
- Stuffy or runny nose
There are many unlisted symptoms that you might experience. It also depends on a case-by-case basis. Consult your health care provider for complete information on the symptoms and their severity according to your personal circumstances.
Working Of Mifepristone
As mentioned above, there are two main benefits of mifepristone. First, its ability to terminate a pregnancy by acting as an abortion pill. Second, its ability to control high blood sugar levels.
1. Medical Abortion (Abortion Pill)
Mifepristone acts as an antiprogesterone when taken as Mifeprex. That is, it works to effectively block the production of progesterone in the woman’s body.
Progesterone is a sex hormone vital for the growth of the pregnancy. It also aids in accepting and nurturing the fertilized egg. By blocking this hormone, mifepristone acts as an abortion pill, thus facilitating a medical abortion.
Mifepristone also helps in relaxing and opening the mouth of the womb (cervix) and makes it sensitive to prostaglandins. Prostaglandins effectively facilitate contractions in the uterus leading to the expulsion of the uterine contents.
Misoprostol (Cytotec) is another medicine that is to follow mifepristone for terminating an implanted pregnancy. Taking them both to ensure the maximum efficacy of medical abortion is extremely vital. Otherwise, it can lead to a number of complications like excessive bleeding, birth defects, preterm birth.
Also Read: Medical Abortion Myths
2. Managing Blood Sugar Levels
Mifepristone works through the drug Korlym to act as an antiglucocorticoid. It controls high blood sugar levels (hyperglycemia) in patients of a certain type of Cushing’s syndrome.
This disease causes its patients to develop high levels of a hormone called cortisol in their bloodstream (hypercortisolism). Hypercortisolism ultimately results in glucose intolerance or type 2 diabetes mellitus.
Thus, mifepristone functions by inhibiting the activity of cortisol to reduce blood sugar levels. People who have Cushing’s syndrome went through a failed surgery, or are not the ideal candidates for surgery usually opt for this drug for treatment.
There are hundreds of drugs and a few other substances that can react with mifepristone to cause casualties. They might increase the risk of the frequency or severity of the side-effects. It is important to consider them and administer mifepristone carefully while consumption. Some of the most common interactions include:
Oxytocin and mifepristone can react together to cause an abnormal heart rhythm. Though rare, this side-effect can be extremely life-threatening.
Cardiovascular disease patients and people who suffer from insufficient magnesium or potassium (electrolyte disturbances) carry a higher risk of being affected by these side-effects. It is important to report to the doctor if you experience any symptoms of low potassium or magnesium including:
- Stomach and muscle cramps
- Swollen legs or feet
- Increased heart rate
- Chest ache
- Numb or tingling sensations
A lack of these electrolytes can be caused by excessive vomiting, diarrhea, or even long-term use of mifepristone. Since mifepristone can stay in the bloodstream for a long time, it is important to take oxytocin after a considerable amount of time to avoid any unwanted interactions.
Mifepristone can cause the amount of methylergonovine to rise in the blood. This can result in an increased risk of the frequency or severity of the side-effects caused by methylergonovine. Since mifepristone stays in the blood for prolonged periods, the interaction can happen even if you have not taken it in a while.
Food can lead to a rise in the blood levels of mifepristone. If you are on chronic treatment, you can take the drug with meals.
However, ensure consistency if you are taking this medication with food. Inconsistency can lead to complications. The drug can be consumed without considering the meals only if your dose is limited to once or twice.
Grapefruit and grapefruit juice are to be completely avoided during mifepristone therapy. They can cause the blood levels of the drug to rise to unwanted levels. This can result in the increased severity of the side-effects of mifepristone.
4. Organ Transplant
People who have gone through an organ transplant usually require corticosteroids to reduce the activity of the immune system. Mifepristone is an antagonist with regard to corticosteroids. Thus, it is contradicted in organ transplant patients.
5. Vaginal Bleeding
Mifepristone encourages the multiplication of cells in the endometrium. This can lead to thickening of the endometrium lining, cystic expansion of endometrial glands, and vaginal bleeding. Thus, under certain circumstances, some women should avoid taking mifepristone.
These majorly include underlying health conditions like:
- Unexplained vaginal bleeding
- Endometrial hyperplasia with atypia (excessive thickening of uterine lining due to the presence of precancerous cells)
- Endometrial carcinoma (cancer of the uterine lining)
- Hemorrhagic disorders
- Women on blood thinners (anticoagulants)
6. Renal And Hepatic Impairment
There is insufficient knowledge about the safety and effectiveness of mifepristone in patients with renal or hepatic impairment. However, the recommended daily dose is not more than 600mg.
Ideally, patients who opt for a medical abortion require at least three visits to the clinic. The first is where they take mifepristone, the second where they take misoprostol, and the third visit is to check if the abortion was successful.
It is important to administer patient care while they are on mifepristone therapy. If any symptoms persist, call the doctor immediately. Do not change the dosage without speaking with your healthcare provider. Avoid sharing the drug with others and keep it out of the reach of children.
December 22, 2020 Sam Bell